Provider Demographics
NPI:1972147239
Name:CHILDREN'S SURGERY CENTER OF PHILADELPHIA LLC
Entity Type:Organization
Organization Name:CHILDREN'S SURGERY CENTER OF PHILADELPHIA LLC
Other - Org Name:CHILDREN'S DENTAL SURGERY OF PHILADELPHIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF SURGERY OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:717-824-1618
Mailing Address - Street 1:2031 MEADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5729
Mailing Address - Country:US
Mailing Address - Phone:717-824-1618
Mailing Address - Fax:
Practice Address - Street 1:2301 E ALLEGHENY AVE STE 301M
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:717-824-1618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty